Biopsy validation of 18F-DOPA PET and biodistribution in gliomas for neurosurgical planning and radiotherapy target delineation: results of a prospective pilot study
Delineation of glioma extent for surgical or radiotherapy planning is routinely based on MRI. There is increasing awareness that contrast enhancement on T1-weighted images (T1-CE) may not reflect the entire extent of disease. The amino acid tracer (18)F-DOPA (3,4-dihydroxy-6-[18F] fluoro-l-phenylala...
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| Veröffentlicht in: | Neuro-oncology (Charlottesville, Va.) Va.), 2013-08, Vol.15 (8), p.1058-1067 |
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| creator | Pafundi, Deanna H Laack, Nadia N Youland, Ryan S Parney, Ian F Lowe, Val J Giannini, Caterina Kemp, Brad J Grams, Michael P Morris, Jonathan M Hoover, Jason M Hu, Leland S Sarkaria, Jann N Brinkmann, Debra H |
| description | Delineation of glioma extent for surgical or radiotherapy planning is routinely based on MRI. There is increasing awareness that contrast enhancement on T1-weighted images (T1-CE) may not reflect the entire extent of disease. The amino acid tracer (18)F-DOPA (3,4-dihydroxy-6-[18F] fluoro-l-phenylalanine) has a high tumor-to-background signal and high sensitivity for glioma imaging. This study compares (18)F-DOPA PET against conventional MRI for neurosurgical biopsy targeting, resection planning, and radiotherapy target volume delineation.
Conventional MR and (18)F-DOPA PET/CT images were acquired in 10 patients with suspected malignant brain tumors. One to 3 biopsy locations per patient were chosen in regions of concordant and discordant (18)F-DOPA uptake and MR contrast enhancement. Histopathology was reviewed on 23 biopsies. (18)F-DOPA PET was quantified using standardized uptake values (SUV) and tumor-to-normal hemispheric tissue (T/N) ratios.
Pathologic review confirmed glioma in 22 of 23 biopsy specimens. Thirteen of 16 high-grade biopsy specimens were obtained from regions of elevated (18)F-DOPA uptake, while T1-CE was present in only 6 of those 16 samples. Optimal (18)F-DOPA PET thresholds corresponding to high-grade disease based on histopathology were calculated as T/N > 2.0. In every patient, (18)F-DOPA uptake regions with T/N > 2.0 extended beyond T1-CE up to a maximum of 3.5 cm. SUV was found to correlate with grade and cellularity.
(18)F-DOPA PET SUV(max) may more accurately identify regions of higher-grade/higher-density disease in patients with astrocytomas and will have utility in guiding stereotactic biopsy selection. Using SUV-based thresholds to define high-grade portions of disease may be valuable in delineating radiotherapy boost volumes. |
| doi_str_mv | 10.1093/neuonc/not002 |
| format | Article |
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Conventional MR and (18)F-DOPA PET/CT images were acquired in 10 patients with suspected malignant brain tumors. One to 3 biopsy locations per patient were chosen in regions of concordant and discordant (18)F-DOPA uptake and MR contrast enhancement. Histopathology was reviewed on 23 biopsies. (18)F-DOPA PET was quantified using standardized uptake values (SUV) and tumor-to-normal hemispheric tissue (T/N) ratios.
Pathologic review confirmed glioma in 22 of 23 biopsy specimens. Thirteen of 16 high-grade biopsy specimens were obtained from regions of elevated (18)F-DOPA uptake, while T1-CE was present in only 6 of those 16 samples. Optimal (18)F-DOPA PET thresholds corresponding to high-grade disease based on histopathology were calculated as T/N > 2.0. In every patient, (18)F-DOPA uptake regions with T/N > 2.0 extended beyond T1-CE up to a maximum of 3.5 cm. SUV was found to correlate with grade and cellularity.
(18)F-DOPA PET SUV(max) may more accurately identify regions of higher-grade/higher-density disease in patients with astrocytomas and will have utility in guiding stereotactic biopsy selection. Using SUV-based thresholds to define high-grade portions of disease may be valuable in delineating radiotherapy boost volumes.</description><identifier>ISSN: 1522-8517</identifier><identifier>EISSN: 1523-5866</identifier><identifier>DOI: 10.1093/neuonc/not002</identifier><identifier>PMID: 23460322</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adult ; Aged ; Brain Neoplasms - diagnostic imaging ; Brain Neoplasms - pathology ; Brain Neoplasms - surgery ; Clinical Investigations ; Dihydroxyphenylalanine - analogs & derivatives ; Dihydroxyphenylalanine - pharmacokinetics ; Female ; Follow-Up Studies ; Glioma - diagnostic imaging ; Glioma - pathology ; Glioma - surgery ; Humans ; Immunoenzyme Techniques ; Male ; Middle Aged ; Neoplasm Grading ; Neurosurgical Procedures ; Pilot Projects ; Positron-Emission Tomography ; Prognosis ; Prospective Studies ; Radiopharmaceuticals - pharmacokinetics ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Image-Guided ; Surgery, Computer-Assisted ; Tissue Distribution ; Young Adult</subject><ispartof>Neuro-oncology (Charlottesville, Va.), 2013-08, Vol.15 (8), p.1058-1067</ispartof><rights>The Author(s) 2013. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3312-eb87dd8e722fcd2ffbd7ccbd0e57d921c6f7a7aa49de00f03c183aabd05d496b3</citedby><cites>FETCH-LOGICAL-c3312-eb87dd8e722fcd2ffbd7ccbd0e57d921c6f7a7aa49de00f03c183aabd05d496b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714146/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714146/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23460322$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pafundi, Deanna H</creatorcontrib><creatorcontrib>Laack, Nadia N</creatorcontrib><creatorcontrib>Youland, Ryan S</creatorcontrib><creatorcontrib>Parney, Ian F</creatorcontrib><creatorcontrib>Lowe, Val J</creatorcontrib><creatorcontrib>Giannini, Caterina</creatorcontrib><creatorcontrib>Kemp, Brad J</creatorcontrib><creatorcontrib>Grams, Michael P</creatorcontrib><creatorcontrib>Morris, Jonathan M</creatorcontrib><creatorcontrib>Hoover, Jason M</creatorcontrib><creatorcontrib>Hu, Leland S</creatorcontrib><creatorcontrib>Sarkaria, Jann N</creatorcontrib><creatorcontrib>Brinkmann, Debra H</creatorcontrib><title>Biopsy validation of 18F-DOPA PET and biodistribution in gliomas for neurosurgical planning and radiotherapy target delineation: results of a prospective pilot study</title><title>Neuro-oncology (Charlottesville, Va.)</title><addtitle>Neuro Oncol</addtitle><description>Delineation of glioma extent for surgical or radiotherapy planning is routinely based on MRI. There is increasing awareness that contrast enhancement on T1-weighted images (T1-CE) may not reflect the entire extent of disease. The amino acid tracer (18)F-DOPA (3,4-dihydroxy-6-[18F] fluoro-l-phenylalanine) has a high tumor-to-background signal and high sensitivity for glioma imaging. This study compares (18)F-DOPA PET against conventional MRI for neurosurgical biopsy targeting, resection planning, and radiotherapy target volume delineation.
Conventional MR and (18)F-DOPA PET/CT images were acquired in 10 patients with suspected malignant brain tumors. One to 3 biopsy locations per patient were chosen in regions of concordant and discordant (18)F-DOPA uptake and MR contrast enhancement. Histopathology was reviewed on 23 biopsies. (18)F-DOPA PET was quantified using standardized uptake values (SUV) and tumor-to-normal hemispheric tissue (T/N) ratios.
Pathologic review confirmed glioma in 22 of 23 biopsy specimens. Thirteen of 16 high-grade biopsy specimens were obtained from regions of elevated (18)F-DOPA uptake, while T1-CE was present in only 6 of those 16 samples. Optimal (18)F-DOPA PET thresholds corresponding to high-grade disease based on histopathology were calculated as T/N > 2.0. In every patient, (18)F-DOPA uptake regions with T/N > 2.0 extended beyond T1-CE up to a maximum of 3.5 cm. SUV was found to correlate with grade and cellularity.
(18)F-DOPA PET SUV(max) may more accurately identify regions of higher-grade/higher-density disease in patients with astrocytomas and will have utility in guiding stereotactic biopsy selection. Using SUV-based thresholds to define high-grade portions of disease may be valuable in delineating radiotherapy boost volumes.</description><subject>Adult</subject><subject>Aged</subject><subject>Brain Neoplasms - diagnostic imaging</subject><subject>Brain Neoplasms - pathology</subject><subject>Brain Neoplasms - surgery</subject><subject>Clinical Investigations</subject><subject>Dihydroxyphenylalanine - analogs & derivatives</subject><subject>Dihydroxyphenylalanine - pharmacokinetics</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glioma - diagnostic imaging</subject><subject>Glioma - pathology</subject><subject>Glioma - surgery</subject><subject>Humans</subject><subject>Immunoenzyme Techniques</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Grading</subject><subject>Neurosurgical Procedures</subject><subject>Pilot Projects</subject><subject>Positron-Emission Tomography</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Radiopharmaceuticals - pharmacokinetics</subject><subject>Radiotherapy Planning, Computer-Assisted</subject><subject>Radiotherapy, Image-Guided</subject><subject>Surgery, Computer-Assisted</subject><subject>Tissue Distribution</subject><subject>Young Adult</subject><issn>1522-8517</issn><issn>1523-5866</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkUtv1DAUha0KRF8su0VesknrR-JkWCCV0gJSpXbRrq0b-yY18tjBdkaaH8T_JJ0pFaxsyZ_POfceQs44O-dsJS8CzjGYixALY-KAHPFGyKrplHqzu4uqa3h7SI5z_rkAvFH8HTkUslZMCnFEfn9xccpbugHvLBQXA40D5d1N9fXu_pLeXz9QCJb2LlqXS3L9vGNcoKN3cQ2ZDjHRJUSKeU6jM-Dp5CEEF8bdzwTWxfKECaYtLZBGLNSidwF3bp9owjz7kp9tgU6LzISmuA3SyflYaC6z3Z6StwP4jO9fzhPyeHP9cPW9ur379uPq8rYyUnJRYd-11nbYCjEYK4aht60xvWXYtHYluFFDCy1AvbLI2MCk4Z0EWIDG1ivVyxPyea87zf0arcFQEng9JbeGtNURnP7_JbgnPcaNli2vea0WgY8vAin-mjEXvXbZoF82gnHOmjcNV1yJtl7Qao-aZeaccHi14Uw_V6v31ep9tQv_4d9sr_TfLuUfGeioHA</recordid><startdate>201308</startdate><enddate>201308</enddate><creator>Pafundi, Deanna H</creator><creator>Laack, Nadia N</creator><creator>Youland, Ryan S</creator><creator>Parney, Ian F</creator><creator>Lowe, Val J</creator><creator>Giannini, Caterina</creator><creator>Kemp, Brad J</creator><creator>Grams, Michael P</creator><creator>Morris, Jonathan M</creator><creator>Hoover, Jason M</creator><creator>Hu, Leland S</creator><creator>Sarkaria, Jann N</creator><creator>Brinkmann, Debra H</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope><scope>5PM</scope></search><sort><creationdate>201308</creationdate><title>Biopsy validation of 18F-DOPA PET and biodistribution in gliomas for neurosurgical planning and radiotherapy target delineation: results of a prospective pilot study</title><author>Pafundi, Deanna H ; 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There is increasing awareness that contrast enhancement on T1-weighted images (T1-CE) may not reflect the entire extent of disease. The amino acid tracer (18)F-DOPA (3,4-dihydroxy-6-[18F] fluoro-l-phenylalanine) has a high tumor-to-background signal and high sensitivity for glioma imaging. This study compares (18)F-DOPA PET against conventional MRI for neurosurgical biopsy targeting, resection planning, and radiotherapy target volume delineation.
Conventional MR and (18)F-DOPA PET/CT images were acquired in 10 patients with suspected malignant brain tumors. One to 3 biopsy locations per patient were chosen in regions of concordant and discordant (18)F-DOPA uptake and MR contrast enhancement. Histopathology was reviewed on 23 biopsies. (18)F-DOPA PET was quantified using standardized uptake values (SUV) and tumor-to-normal hemispheric tissue (T/N) ratios.
Pathologic review confirmed glioma in 22 of 23 biopsy specimens. Thirteen of 16 high-grade biopsy specimens were obtained from regions of elevated (18)F-DOPA uptake, while T1-CE was present in only 6 of those 16 samples. Optimal (18)F-DOPA PET thresholds corresponding to high-grade disease based on histopathology were calculated as T/N > 2.0. In every patient, (18)F-DOPA uptake regions with T/N > 2.0 extended beyond T1-CE up to a maximum of 3.5 cm. SUV was found to correlate with grade and cellularity.
(18)F-DOPA PET SUV(max) may more accurately identify regions of higher-grade/higher-density disease in patients with astrocytomas and will have utility in guiding stereotactic biopsy selection. Using SUV-based thresholds to define high-grade portions of disease may be valuable in delineating radiotherapy boost volumes.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>23460322</pmid><doi>10.1093/neuonc/not002</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; PMC (PubMed Central); EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Aged Brain Neoplasms - diagnostic imaging Brain Neoplasms - pathology Brain Neoplasms - surgery Clinical Investigations Dihydroxyphenylalanine - analogs & derivatives Dihydroxyphenylalanine - pharmacokinetics Female Follow-Up Studies Glioma - diagnostic imaging Glioma - pathology Glioma - surgery Humans Immunoenzyme Techniques Male Middle Aged Neoplasm Grading Neurosurgical Procedures Pilot Projects Positron-Emission Tomography Prognosis Prospective Studies Radiopharmaceuticals - pharmacokinetics Radiotherapy Planning, Computer-Assisted Radiotherapy, Image-Guided Surgery, Computer-Assisted Tissue Distribution Young Adult |
| title | Biopsy validation of 18F-DOPA PET and biodistribution in gliomas for neurosurgical planning and radiotherapy target delineation: results of a prospective pilot study |
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